Initiation of haploidentical stem cell transplantation with post-transplant cyclophosphamide in children: A low-middle-income country institutional experience

Authors

Syed Ibrahim Bukhari, Aga Khan UniversityFollow
Javeria Saeed, Aga Khan UniversityFollow
Zehra Fadoo, Aga Khan UniversityFollow
Asim Belgaumi, Aga Khan UniversityFollow
Naureen Allani, Aga Khan UniversityFollow
Sadaf Altaf, Aga Khan UniversityFollow

Document Type

Article

Department

Radiation Oncology; Surgery; Haematology/Oncology

Abstract

Background: Haploidentical hematopoietic stem cell transplant (HSCT) is a curative treatment especially for countries where bone marrow registries are nonexistent. We present our experience with haploidentical HSCT in pediatric patients.
Methods: Retrospective data collected and analyzed for patients ≤18 years, from January 2017 to December 2022.
Results: The cohort consisted of 20 patients with median age at transplant of 61.5 (IQR: 124) months. Fourteen (70%) were malignant and 6 (30%) were benign diseases. Donors were father in majority (9/20; 45%). Stem cell source was peripheral blood 8, marrow 8, and combined 4. c-specific antibodies were positive in 6 (30%). Median CD34 cell dose infused: 9.35 × 106/kg. Median engraftment time: 15 (IQR: 17) days. Acute and chronic graft-versus-host disease (GVHD) occurred in 12/20 (60%) and 5/20 (25%), respectively. Complications included infection/sepsis (14/20; 70%), cytomegalovirus reactivation (14/20; 70%), sinusoidal obstruction syndrome (1/20; 5%), primary graft failure (PGF) (6/20; 30%), and secondary graft failure (4/20; 20%). PGF was more common in benign conditions (p = 0.003) and less prevalent in cases with aGVHD (p = 0.007). aGVHD was more common in malignant conditions (p = 0.007). Overall survival (OS), relapse-free survival (RFS), and treatment-related mortality (TRM) were 40%, 50%, and 35%, respectively. Median time of survival and relapse were 8 (IQR: 15) and 9 (IQR: 13) months, respectively.
Conclusion: OS was comparable to that of other low-middle-income countries. GVHD was a major challenge, along with sepsis and CMV infection. Half of the leukemias relapsed. Graft failure was a major concern in nonmalignant diseases.

Comments

Pagination are not provided by the author/publisher.

Publication (Name of Journal)

Pediatric Transplantation

DOI

10.1111/petr.14842

Recommended Citation

Bukhari, S. I., Saeed, J., Fadoo, Z., Belgaumi, A., Allani, N., Altaf, S. (2024). Initiation of haploidentical stem cell transplantation with post-transplant cyclophosphamide in children: A low-middle-income country institutional experience. Pediatric Transplantation, 28(6), e14842.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncol/119